Arrowhead Begins Phase 1 Trial of ARC-AAT for Treatment of Liver Disease Associated with Alpha-1 Antitrypsin Deficiency
The Phase 1 trial is a multi-center, randomized, placebo-controlled, double-blind, single dose-escalation first-in-human study to evaluate the safety, tolerability, pharmacokinetics of ARC-AAT and the effect on circulating alpha-1 antitrypsin (AAT) levels. The study plans to enroll in dose cohorts of six participants each, with participants randomized at a ratio of 2:1 (active:placebo) to receive a single intravenous injection of either ARC-AAT or placebo (normal saline). The study will consist of two parts, with Part A planned to be conducted in healthy volunteers and Part B planned to be conducted in patients with PiZZ genotype AATD. In Part A, dose escalation will proceed until the achievement of certain target knockdown parameters. When these AAT knockdown parameters are achieved, dose escalation in healthy volunteers (Part A) is planned to stop and dosing in patients with AATD (Part B) is planned to begin at the highest dose level used in Part A and then dose escalation will proceed. We expect participants will be evaluated for 28 days following dosing with additional follow-up every 2 weeks until AAT levels return to baseline.
"The whole Alpha-1 community is excited to see this landmark clinical
trial begin for Alpha-1 liver disease," said
ARC-AAT is the second clinical candidate to use Arrowhead's proprietary
Dynamic Polyconjugate (DPC) delivery platform and includes an optimized
RNAi-trigger design that contains an unlocked nucleobase analog (UNA)
and various chemical modifications that enhance activity and
substantially extend the duration of effect in non-clinical studies.
Arrowhead previously reported data from these studies at an analyst day
the company held in
About ARC-AAT
Arrowhead's ARC-AAT is being investigated for the treatment of liver disease associated with Alpha-1 Antitrypsin Deficiency (AATD), a rare genetic disease that severely damages the liver and lungs of affected individuals. ARC-AAT employs a novel unlocked nucleobase analog (UNA) containing RNAi trigger molecule designed for systemic delivery using the Dynamic Polyconjugate delivery system. ARC-AAT is highly effective at knocking down the Alpha-1 antitrypsin (AAT) gene transcript and reducing the hepatic production of the mutant AAT (Z-AAT) protein. Reduction of liver production of the inflammatory Z-AAT protein, which has been clearly defined as the cause of progressive liver disease in AATD patients, is important as it is expected to halt the progression of liver disease and potentially allow fibrotic tissue repair. The Company is conducting a single dose Phase 1 clinical study, with part A in healthy volunteers and part B in AATD patients.
About Alpha-1 Antitrypsin Deficiency (AATD)
AATD is a co-dominant genetic disorder associated with liver disease in children and adults and pulmonary disease in adults. Alpha-1 antitrypsin is a circulating glycoprotein protease inhibitor of the serpin family encoded by the AAT gene and primarily synthesized in the liver. The physiologic function is inhibition of neutrophil proteases to protect healthy tissues during inflammation and prevent tissue damage. The Z mutant is the most common disease variant and has a single amino acid substitution that results in improper protein folding causing severe impairment of secretion from hepatocytes. This lack of secretion leads to accumulation of mutant Z-AAT polymers, which form globules in the hepatocyte endoplasmic reticulum. This triggers continuous hepatocyte injury, leading to fibrosis, cirrhosis, and increased risk of hepatocellular carcinoma.
In clinical practice, approximately 96-98% of AATD-related disease is due to the homozygous PiZZ genotype. PiZZ individuals have severe deficiency of functional AAT leading to pulmonary disease and hepatocyte injury and liver disease. Lung disease is frequently treated with AAT augmentation therapy. However, augmentation therapy does nothing to treat liver disease, and there is no specific therapy for hepatic manifestations. There is a significant unmet need as liver transplant is currently the only available cure.
The mean estimated prevalence of AATD in the U.S is 1 per 3000-5000, or approximately 100,000 patients. AATD is also an important cause of pediatric liver disease with an estimated prevalence in children of approximately 20,000 patients, and 50-80% likely to manifest liver dysfunction during childhood. It is considered to be a relatively high prevalence orphan disease, and it is frequently misdiagnosed or undiagnosed. European prevalence is estimated to be 1 per 2500.
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